Jamaluddin Moloo, MD, MPH

In a prospective study, incorporating premature atrial contraction counts improved AF risk prediction.

Studies have shown that premature atrial contractions (PACs) can initiate atrial fibrillation (AF) and that PACs are associated with incident AF. To evaluate further the contribution of PACs to prediction of risk for AF, researchers investigated the PAC count in 1260 older adults (mean age, 71) without AF who were enrolled in a multicenter, prospective, U.S. cardiovascular study. Participants underwent 24-hour Holter monitoring at baseline and were followed for incident AF with annual electrocardiograms and by hospital-discharge data.

During median follow-up of 13 years, 27% of participants developed AF. The median hourly PAC count at baseline was significantly higher among those with incident AF than among those who did not develop AF (5.3 vs. 1.8 beats/hour); adjusted hazard ratio for incident AF was 4.92 among those in the highest versus the lowest quartiles of hourly PAC frequency. Addition of PAC frequency to the Framingham AF risk model significantly improved 10-year AF risk discrimination.

Citation(s):

Dewland TA et al. Atrial ectopy as a predictor of incident atrial fibrillation: A cohort study. Ann Intern Med 2013 Dec 3; 159:721.